Applicability of the adapted Moral Distress Scale in the context of nursing in hemato-oncology services

Fruet, Isolina Maria Alberto; Dalmolin, Graziele de Lima; Barlem, Edison Luiz Devos; Silva, Rosangela Marion da; Andolhe, Rafaela

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Revista Gaúcha de Enfermagem

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Original Article • Rev. Gaúcha Enferm. 38 (04) • 2017 • https://doi.org/10.1590/1983-1447.2017.04.63060 copy

Applicability of the adapted Moral Distress Scale in the context of nursing in hemato-oncology services

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

OBJECTIVE

To verify the applicability of the adapted Moral Distress Scale in the nursing setting of the hemato-oncology sector of a university hospital.

METHOD

Cross-sectional study conducted with 46 nursing workers of a university hospital in the southern region of Brazil with data collected between December 2014 and March 2015 by means of the adapted Moral Distress Scale. Factor analysis, Cronbach's alpha, and descriptive statistics were used to analyze the data.

RESULTS

Factor analysis resulted in a group of 26 questions validated based on three factors: Lack of Competence in the Team, Denial of the Nursing Role as the Patient’s Advocate, and Disrespect for the Patient’s Autonomy. Cronbach’s alpha of the instrument was 0.98.

CONCLUSION

This study showed that the adapted Moral Distress Scale is an appropriate instrument for the identification of moral distress in nursing workers in the hemato-oncology area.

Keywords:
Occupational health; Nursing; Ethics; Oncologic service; hospital

Question	Block	F1	F2	F3
Lack of competence in the work team
Q25 - Working with nursing technicians/aides who do not present the necessary skills required by the condition of the patient.	0.910	0.845	0.334	0.289
Q31 - Working with physicians who are not sufficiently qualified to work.	0.859	0.821	0.334	0.273
Q27 - Working with physicians who do not present the necessary skills required by the patient’s condition.	0.863	0.797	0.257	0.403
Q30 - Working with nursing technicians/aides who are not sufficiently qualified to work.	0.916	0.794	0.463	0.266
Q33 - Working with medical or nursing students who are not sufficiently qualified to work.	0.845	0.792	0.413	0.217
Q28 - Working with support services that do not present the necessary competence required by the patient’s condition.	0.870	0.791	0.314	0.382
Q24 - Working with nurses who do not present the necessary skills required by the patient’s condition.	0.886	0.772	0.404	0.356
Q29 - Working with nurses who are not sufficiently qualified to work.	0.937	0.761	0.519	0.297
Q26 - Working with medical or nursing students who do not present the necessary skills required by the patient’s condition.	0.859	0.750	0.426	0.338
Q32 - Working with support services that are not sufficiently qualified to work.	0.860	0.729	0.477	0.317
Denial of the nursing role as the patient’s advocate
Q07 - Ignoring situations in which the patient was not provided with the appropriate information to ensure their informed consent.	0.909	0.275	0.842	0.353
Q10 - Allowing medical students to perform painful procedures in patients just to improve their skills.	0.834	0.264	0.831	0.272
Q09 - Avoiding taking action upon observing that a nursing team member applies the wrong medication, and failing to report the case.	0.826	0.412	0.803	0.104
Q38 - Avoiding taking action when observing abandonment of a terminal patient by the health team.	0.872	0.472	0.757	0.274
Q16 - Observing without taking action when the nursing team disrespects the privacy of the patient.	0.757	0.511	0.704	0.029
Q39 - Avoiding taking action when observing abandonment of a terminal patient by the family.	0.747	0.500	0.701	0.078
Q34 - Avoiding taking action in situations of death of patients associated with professional negligence.	0.785	0.534	0.699	0.108
Q12 - Executing medical prescriptions to conduct unnecessary exams and treatments in terminally ill patients.	0.829	0.194	0.695	0.555
Q18 - Assisting a physician who, in your opinion, is acting in an incompetent way in relation to the patient.	0.813	0.537	0.673	0.269
Q11 - Assisting physicians performing procedures in patients after unsatisfactory cardiorespiratory recovery.	0.610	0.286	0.653	0.320
Q13 - Working with the nursing team at a level considered “unsafe”.	0.752	0.540	0.614	0.288
Q17 - Obeying the medical order not to tell the truth to a patient, even when the patient asks for it.	0.771	0.389	0.595	0.515
Disrespect for the patient’s autonomy
Q02 - Respecting the will of the family in relation to the maintenance of life of the patient, although this is not the best for them.	0.635	0.305	0.088	0.731
Q21 - Complying with the physician’s order not to discuss with the patient about their resuscitation in case of cardiac arrest.	0.848	0.405	0.400	0.724
Q22 - Complying with the physician’s order not to discuss with the family about the resuscitation of the patient in case of cardiac arrest when the patient is deprived of discernment.	0.762	0.245	0.449	0.707
Q36 - Working with professionals who do not clarify the patient about their health and disease condition.	0.782	0.524	0.450	0.553
Initial Eigenvalues		18.31	1.69	1.33
% variance explained 82.07		70.42	6.51	5.13
Cronbach’s Alpha (instrument: 0.98)		0.98	0.97	0.86
Kaiser-Meyer-Olkin Test (KMO): 0.884
Bartlet test: chi-square = 1751.752 (325)

Factor	F1	F2	F3
Lack of competence in the work team (F1)		.838^ Pearson’s correlation (p<0.001)	.773^ Pearson’s correlation (p<0.001)
Denial of the nursing role as the patient’s advocate (F2)	.838^ Pearson’s correlation (p<0.001)		.729^ Pearson’s correlation (p<0.001)
Disrespect for the patient’s autonomy (F3)	.773^ Pearson’s correlation (p<0.001)	.729^ Pearson’s correlation (p<0.001)

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[1] Corresponding author:
Graziele de Lima Dalmolin.grazi.dalmolin@gmail.com